Purpose
There are over 2300 people living with dementia in Hounslow, and the borough has the second highest emergency hospital admissions rate for people living with dementia in London. This has led to an increased demand on hospitals, and on residential and nursing care. Also, for the last 5.5 years a substantial number of people have consistently remained undiagnosed in Hounslow.
Timely diagnosis helps the patient and their family/carers to know what to expect, so they can consider future mental capacity and plan ahead.
It is apparent that many of our residents are not sufficiently informed about the ways in which they can plan for future decision-making at a time when they lack capacity to do so for themselves. Planning can ensure that explicitly stated personal values/wishes are known by one or more selected and trusted persons, so key decisions can be made on their behalf. This will greatly increase the likelihood that future health and care decisions, and management of their property and finances would reflect expressed wishes.
NHS England set a national goal in 2019 to increase the number of people being diagnosed with dementia and starting treatment from 6 weeks of referral to a memory service. The London region set a local ambition to work towards 85% of people being diagnosed within 6 weeks of referral. London ICBs are required to submit monthly data to NHSE/I on the percentage of people diagnosed within 6 weeks of referral, and the average wait time for diagnosis. The Hounslow CIDS/Memory Service activity from April 2022 to October 2022 demonstrated that the average wait time for diagnosis of dementia as of October 2022 was nearly 15 weeks for Hounslow residents.
The BBP aims to help improve the quality of life for people living with dementia and their families by providing more patients with community support with their diagnosis, and offering services that can help prevent crisis, prevent unwarranted hospital admissions, and enable more people living with dementia to live independently in their own home.
- Improve early diagnosis and post-diagnosis support, and a prospect for future planning
- Reduce unwarranted A&E/hospital admissions and breakdown of care by providing appropriate/focused/proactive & integrated care
- Develop cost-efficient and sustainable models of care to support more people with dementia diagnosis at home
- Upskill and support frontline staff around whole-person integrated care, delivered and adapted in response to patient’s changing need.
- Work towards Hounslow being a borough where people with dementia and their carers, are understood, respected, and supported. We aim that people will be aware of and understand dementia, and people with dementia will feel included and involved, and have choice and control over their day to day lives.
- Work to increase understanding of dementia and reduce stigma, to increase opportunities for people living with dementia to get out and live well, to improve accessibility to the physical environment, and to improve understanding of the support that is available.
Deliver targeted and integrated care to improve health and wellbeing of dementia patients and their carers through integrated care planning and timely delivery of support; number of integrated care plans implemented.
In April 2023 the BBP funded a new broader Enhanced Dementia Care Service (EDCS) for two years. The EDCS is a multi-organisation service that consists of health, social care and voluntary services that supports residents seven days a week. The service will be managed and delivered by Hounslow and Richmond Community Healthcare Trust in conjunction with Hestia.
To gain a better understanding of the EDCS please watch the following quick video:
For further details on EDCS please visit https://www.hounslowhealthandcare.org/news-and-campaigns/news/hounslow-enhanced-dementia-care-service-launch
EDCS data captured between April 2023 – February 2024 demonstrated significant results for a cohort of 185 patients, who saw a significant reduction in hospital activity post-referral resulting in:
- 29% reduction in non-elective admissions,
- 36% reduction in non-elective bed days
- 17% reduction in ED attendances
By evolving the team into a functioning multidisciplinary team operating 7 days a week, the team can deliver improved responsiveness by the correct professional at the right time as there is no break in the continuity of service. They can meet wider needs quickly and reduce risks in different ways and by working across different disciplines. EDCS have also improved joint working pathways, and now attend older persons MDT with CIDs.
The team also work closely with the Alzheimer’s society especially in WMUH to support more effective discharge pathways and maintain people at home for longer.
- In 2023 The London Borough of Hounslow was also awarded 'Dementia Friendly Community status' by The Alzheimer’s Society. The Society recognised the boroughs achievements in supporting people who are living with dementia, the award citation stated that Hounslow Council and its partners are working to: “empower people with dementia to have high aspirations, confident in the knowledge that they can contribute and participate in activities that are meaningful to them.
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